NPIMap

Organization Active NPI

Family Tooth Doctor LL, LLC

  • General Practice Dentistry
  • Mesa, AZ
National Provider Identifier
1487792594
Registry record updated Jul 24, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D4215 Issued in AZ
Legal business name
FAMILY TOOTH DOCTOR LL, LLC
Practice address
4435 E Broadway Rd
Suite 9
Mesa, AZ 85206-2012
Phone
(480) 223-0255
Fax
(480) 654-0705
NPI assigned
Feb 1, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
James Frank KingNPI 1215196407
Title
Owner
Phone
(480) 223-0255

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X D4215 AZ Primary

Addresses

Primary practice location

4435 E Broadway Rd
Suite 9
Mesa, AZ 85206-2012

Mailing address

4435 E Broadway Rd
Suite 9
Mesa, AZ 85206-2012
Phone (480) 223-0255

National Provider Directory

National Provider Directory

Locations

4435 E Broadway Rd
Ste 9
Mesa, AZ 85206
Phone (480) 223-0255

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185235200000",
    "number": "1487792594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4435 E BROADWAY RD",
            "address_2": "SUITE 9",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852062012",
            "telephone_number": "480-223-0255",
            "fax_number": "480-654-0705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4435 E BROADWAY RD",
            "address_2": "SUITE 9",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852062012",
            "telephone_number": "480-223-0255",
            "fax_number": "480-654-0705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY TOOTH DOCTOR LL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-01",
        "last_updated": "2007-07-24",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "FRANK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-223-0255"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D4215",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.